Civil Rights Complaint Form (F270-001-000). Civil Rights Complaint Form (F270-001-000) 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out your contact information. Include your first name, last name, address, city, state, zip code, country, email address, and phone number. If applicable, provide an optional phone number for a family member or friend.
3. Indicate your language preference by checking the appropriate box. This ensures that you receive assistance in a language you are comfortable with.
4. In the 'Complaint Details' section, check all types of complaints that apply to you: Language Access or Discrimination based on race, national origin, and/or color.
5. Specify who your complaint is about by selecting from the options provided: L&I employee, medical provider, or other. If known, include their names.
6. Describe your complaint in detail. You can attach additional pages if necessary; just remember to write your name on each attached page.
7. Provide the date when the incident occurred using the month/day/year format and indicate if you have filed a complaint about this issue before.
8. Finally, sign and date the form before submitting it via mail or contacting us for any questions regarding confidentiality or submission.

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